One Stop Housing Online Client Application Form

All fields are required.

 Name :
 E-mail :
 Phone :
 Type of contact : Personal Phone
 Referring Worker :
 Referring Agency :
  • CAST
  • CCAS
  • JSF
  • OTHER
    		•
     Living situation :
  • Housed
  • Shelter
  • Group Home
  • Absolutely Homeless
  • Hidden Homeless
  • Life Program
  • Other
    		•
     Date of Birth - MM/DD/YYYY
     Age :
  • Youth 13-17
  • Adult 18-64
    		•
     Gender :
  • Female
  • Male
  • Trans
    		•
     Citizenship Status :
     Place of Origin :
     Do you have proper Identification?
  • Yes
  • No
    		•
    Sources of Income :
  • OWA
  • ODSPA
  • ECM
  • Employed
  • Other :
    •  Mental Health Issues
  • Mental Health Issues
  • Addiction Issues
  • Both
  • Neither
    		•
    Previous Renting Experience :
  • Yes
  • No
    		•
     Emerging Issues/Challenges :
    Are you getting housing help from any other sources?
  • Yes
  • No
    		•
     If so where? :
    Type of Housing Requested :
  • Room
  • Bachelor
  • 1 Bedroom
  • 2 Bedroom
  • Other
  • Maximum Rent $
    		•
    Location Requested :
  • Toronto East
  • Toronto Central
  • Toronto West
  • York
  • East York
  • Etobicoke
  • North York
  • Scarborough
    		•
    Household Type :
  • Single
  • Single Parent
  • Two Parent
    		•
    Smoking :
  • Yes
  • No
    		•
    Pets :
  • Yes
  • No
    		•
    Last Month's Rent :
  • Yes
  • No
  • Negotiable
    		•
     Deposit :
  • Yes
  • No
    		•
     References :
  • Yes
  • No
    		•